The Oklahoma State Department of Health on Tuesday said it's working to shift from statewide to regional hospital data to inform its weekly COVID-19 alert system.
Public health experts have called Gov. Kevin Stitt’s alert system unhelpful because it lacks granular hospital data. Coronavirus hospitalizations by county or region would be a more useful tool to evaluate county risks — as the alert system purports to do — rather than relying on statewide numbers that can’t pinpoint local trends.
Dr. Dale Bratzler, chief COVID officer for the University of Oklahoma, said the system “is not helpful at this point,” noting on July 17 how the state map was mostly one color despite specific ongoing hot spots in Oklahoma.
The alert system is updated each Friday and relies on county-level infection rates per capita to determine if each county’s risk is new normal (green), low (yellow) or moderate (orange).
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However, the only way a county can reach the high-risk (red) category is if:
• The entire state’s hospital capacity or ventilator availability drops below 5%.
• Hospital personal protective equipment depletes to less than five days worth across the whole state.
So a local hospital system could become overwhelmed, but if there are beds or PPE elsewhere, the risk level remains moderate instead of high in that county or counties.
Dr. Bruce Dart, Tulsa Health Department executive director, on July 30 said the COVID-19 alert system “isn’t going to be real helpful to us” unless it uses a regional concept for hospitalizations rather than statewide metrics.
Stitt and his interim health commissioner have publicly said they would release localized data on COVID-19 hospitalizations, but a month later that information remains private.
Rob Crissinger, an OSDH spokesman, on Tuesday said the agency should be releasing "something soon" but that he doesn't have specific details on what form the data might take or how often the data would be released.
"We’re still making the shift from statewide hospital data triggers to the regional approach on the COVID-19 Alert System that aligns with the updated hospital surge plan," Crissinger wrote.
A potential value of publicly releasing regional COVID-19 hospital data to analyze local trends was illustrated July 23.
Dr. George Monks, president of the Oklahoma State Medical Association, posted on social media that a local COVID-19 patient was in an emergency room at 8:30 a.m. July 22 in need of a bed but unable to be placed in one until the "one and only bed in the entire Tulsa metro area became available" after 5:30 p.m.
A state spokeswoman said the state was unable to confirm details of Monks' post with Tulsa hospitals.
Nine days after a Tulsa World open records request for more granular hospital data, Stitt was asked whether regional hospital data would be used to better inform the state's risk map.
“If it’s not out there, we certainly have that and we track it and I can make that available,” Stitt said, adding that his nightly COVID-19 briefings include regional hospital capacity.
Interim Health Commissioner Lance Frye described the risk map at its July 9 launch as similar to a weather warning system at a county level.
The state failed to list and explain the highest-risk category on its website for the public release, meaning Oklahomans might not have realized there was a red category nor understood that local metrics alone wouldn't move their county to a red alert on the state system.
“We’re not going to start and stop our economy and start and stop our economy unless we see some catastrophic issues with our health-care (system) going up to the red level,” the governor said at the time. “I’m going to continue to be transparent with Oklahomans, continue to give them the data and then give them the freedom to make those decisions to protect themselves and their families.”
Video: White House COVID-19 reports show Oklahoma in the red zone since mid-July.
COVID-19 basics everyone needs to know as the pandemic continues
COVID-19 basics everyone needs to know as the pandemic continues
How it spreads, who's at risk
Studies have shown many infected people show no symptoms or have symptoms so mild they may go undetected; those people can still transmit COVID-19 to About 20% of patients diagnosed with COVID-19 require hospitalization.
The disease can be fatal, especially for vulnerable populations: those older than 65, living in a nursing home or long-term care facility, and anyone with underlying health conditions such as diabetes, heart disease, lung disease or obesity.
Science of virus spread
COVID-19 is spread mainly from person to person via respiratory droplets produced by an infected person. Spread is most likely when people are in close contact, within about 6 feet. A person might also be infected with COVID-19 after touching a surface or object that has the virus on it and then touching their face. According to the CDC, evidence suggests the novel coronavirus may remain viable for hours to days on surfaces, though that form of transmission is said to be minor.
Transmission between people more than 6 feet from one another may occur in poorly ventilated and enclosed spaces, the CDC says, especially where activities cause heavier breathing, such as singing or exercising.
The infectious period for patients can begin up to 48 hours before symptom onset.
List of symptoms
The CDC recently expanded its list of possible symptoms of COVID-19. The symptoms can appear from two days to two weeks after exposure.
- Fever or chills
- Cough
- Shortness of breath or difficulty breathing
- Fatigue
- Muscle or body aches
- Headache
- New loss of taste or smell
- Sore throat
- Congestion or runny nose
- Nausea or vomiting
- Diarrhea
This list does not include all possible symptoms and will continue to be updated by the CDC. One symptom not included is "purple toes," which someone may experience with no other symptoms, sometimes several weeks after the acute phase of an infection is over. The coloration and pain is caused by a lack of blood flow to the toes caused by excessive blood clotting, a late-stage concern with COVID-19 infections.
Kinds of testing
Those getting tested may experience different kinds of swabs. The viral test, known as PCR, involves a deep nasal swab that can be painful.
Other tests that require less-invasive swabs may produce results faster, but with less accuracy. These should not be used diagnostically.
It is not yet known whether COVID-19 antibodies can protect someone being infected again or how long protection might last.
The 'serious seven'
The "serious seven" refer to close contact environments where residents should take extra precautions if they choose to attend. The seven are gyms, weddings, house gatherings, bars, funerals, faith-based activities and other small events, according to Tulsa Health Department Director Bruce Dart.
Treatments being investigated
The FDA has allowed for antiviral drug remdesivir, previously tested on humans with Ebola, to treat more severe cases of COVID-19 in adults and children. Safety and effectiveness aside, preliminary studies have shown it can shorten recovery time for some patients.
After previously approving an emergency use authorization, the FDA as of July 1 cautions against use of hydroxychloroquine or chloroquine for COVID-19 outside of the hospital setting or a clinical trial. A review of safety issues includes reports of serious heart rhythm problems and other safety issues, including blood and lymph system disorders, kidney injuries, and liver problems and failure.
Convalescent serum therapy
Some patients are receiving convalescent serum, meaning the antibodies made by people who have recovered after a COVID-19 infection. Antibody-rich blood plasma is being given to severely or critically ill COVID-19 patients, including Ascension St. John, Saint Francis Health System, OSU Center for Health Sciences and Hillcrest HealthCare System in Tulsa.
From June to July, requests for convalescent plasma from the Oklahoma Blood Institute multiplied seven-fold.
Recovery, as defined by CDC
To be considered recovered (without a test), these three things must happen, the CDC advises:
- No fever for at least 72 hours (three full days of normal temperature without the use of medicine)
- Other symptoms improved (no more cough, etc.)
- At least 10 days since symptoms first appeared
